My niece has recently been diagnosed with mono. The doctors said mono could be airborne. Is this true? Also, she is having a lot of trouble breathing. She cannot breathe through her nose, and her tongue is swollen, making it hard to breathe and eat. She has lost 14 pounds in one week. She has been given prednisone and cortisone shots but has found no relief. Also, antibiotics haven't helped her condition. Any suggestions?

Bart

Infectious mononucleosis ("mono") is caused by the Epstein-Barr virus (EBV). Mono is sometimes referred to as the "kissing disease," because deep kissing appears to help transmit the infection. This probably explains why so many adolescents develop mono after they start to experiment with kissing. It is possible that virus-laden droplets of saliva could become airborne and then contact someone's mucus membranes to cause infection, but this probably does not occur often.

Mono causes a sore throat, fever and lymph-node swelling. Usually the illness improves after a week or so, with all symptoms resolving in one month. Complications of mono are not common, but they can be severe. The spleen can rupture, causing life-threatening bleeding. The tonsils can swell markedly, resulting in difficulty breathing and swallowing. Rarely, serious blood disorders occur. This includes red-blood-cell destruction, causing anemia. The white-cell count can fall, putting the patient at risk of other infections. The platelets (which help blood clot) can be destroyed, resulting in a high risk of bleeding. Other very rare complications are massive lymph-node swelling and lymphoma, a type of cancer.

The diagnosis of mono is relatively simple, using blood tests that measure the body's infection-fighting antibodies. The simplest is the heterophile test, available in a quick and inexpensive form called Monospot. While this test is not perfect, if it is positive and the patient has typical symptoms, a physician can diagnose mono. If there is any doubt, a more specific antibody test can prove the diagnosis. Not too many disorders can be confused with EBV. Among them are toxoplasmosis, cytomegalovirus (CMV), hepatitis B, acute HIV (the virus that causes AIDS) and occasionally simple strep throat.

Your niece may or may not have an infection due to EBV. That is the first thing I would try to ascertain. If the diagnosis of mono is certain, or nearly so, then in all likelihood, she will get better with no consequences. Her EBV infection can be treated with rest, acetaminophen (Tylenol) for fever, and avoiding sports that could cause injury to the spleen. Ibuprofen (Advil) or other anti-inflammatory drugs may help the throat and lymph-node pain.

Corticosteroids such as prednisone (Deltasone) and cortisone (Cortone) are strong anti-inflammatory medications. They probably speed recovery from the infection but are not generally used, because EBV is a self-limited infection in most cases and there is no known benefit as far as preventing illness and death. The drugs are usually given to patients who have difficulty breathing or a blood disorder.

Antibiotics are effective only against bacteria, not against viruses such as EBV, so they would not be expected to help, unless the patient also has a bacterial infection. Acyclovir, a drug that treats infections of a related virus, herpes, can decrease the replication of EBV. However, it has not been shown to markedly help the patient, so it is generally not given in cases of mono.

You have not told me how long your niece has been ill. If it has been more than two weeks or so, I would be suspicious that some other illness has complicated the picture, or that she never had EBV in the first place. Unfortunately, there is no way to know without a thorough evaluation.